Aortic dissections are a serious, potentially fatal condition affecting the aorta, a large blood vessel in your chest.
Learn more about the causes and treatments available from Dr. John Kern, a UVA thoracic surgeon who specializes in aortic dissections.
Selected Podcast
What Are Aortic Dissections?
Featured Speaker:
John Kern, MD
Dr. John Kern is a board-certified thoracic and cardiac surgeon whose specialties include treating aortic dissections. Transcription:
What Are Aortic Dissections?
Melanie Cole (Host): Aortic dissections are a serious, potentially fatal condition affecting the aorta, a large blood vessel in your chest. My guest today is Dr. John Kern. He is a board certified thoracic and cardiac surgeon, whose speciality includes treating aortic dissections. Welcome to the show, Dr. Kern. What is an aortic dissection? It sounds to some listeners like a type of surgery but what it is really and what causes them?
Dr. John Kern (Guest): Well, thank you, Melanie. As you pointed out, an aortic dissection concerning to be a life threatening problem. If you think of the aortas, as you pointed out as the largest blood vessel in the body, as a hose that has three layers: an inner layer, a middle layer and an outer layer. You imagine that the inner layer develops a crack in it and then the fluid in the hose; in this case, the blood, can get into that crack and dissect, hence the name dissection, dissect along the length of that hose. Fortunately, in the aorta, the outer layer contributes the most strength to the aorta. So, an aortic dissection can be immediately life-threatening but can very often be treated successfully.
Melanie: So, I'd like to start then with risk factors. Are there some certain risk factors that someone would have for aortic dissection?
Dr. Kern: Yes, certainly there are. In fact, aortic dissections occur most commonly in two periods of your life. In the earlier age populations, those folks in their twenties and thirties and then as we get older in our sixties and seventies. In the younger patients, those folks, their risk factors tend to be connective tissue disorders. So, patients with Marfan syndrome and other connective tissue disorders, which renders the aorta more susceptible to developing a dissection. In older patients, it tends to be a combination of uncontrolled blood pressure and enlarge aortas, so, if you have an aneurysm or if you have a family history of an aneurysm anywhere in your aorta, you should probably be screened to make sure you are not at risk.
Melanie: What about symptoms? Everybody always wants to know symptoms. A lot of things can cause pain in the chest and such, so how would you that this something that's going on?
Dr. Kern: Well, that's exactly right. Aortic dissections certainly do have a classic symptom complex and that tends to be an absolute sudden, out of the blue, if you will, tearing type of chest pain. It can start in the front and go to the back. It can start in the back between the shoulder blades and continue down the back and that literally comes from those layers of the aorta separating. So, that's the most classic symptom complex. For dissections, it’s interesting because we often call dissections “the great imitator.” So, dissections can cause symptoms ranging from a heart attack or a stroke. In fact, dissections can cause a heart attack, so that's why you may have more the classic symptoms of heart attack type chest pain. Since aortic dissections can cause a stroke, so that’s why you may present with a true stroke being paralyzed on one side of your body, but dissections can often be very subtle. Sometimes the pain is not so severe. Sometimes patients just have this nagging back pain or they have belly pain or abdominal pain. Sometimes patients come in because the dissection has occluded blood flow to arm or to a leg. So, they come in with their arm or leg not feeling correct. So, dissections really can be the great imitator. I have seen patients with dissections be misdiagnosed with anything from the flu, all the way down to gall stones and they have ended up having their gall bladder taken out.
Melanie: Well, I would imagine it would be quite confusing because many of these symptoms can mimic other conditions. So, how do you find out? If somebody does get a little nervous about their symptoms, if they got to see a doctor or if they go to an emergency room, is there some sort of diagnosis or exam that would show that this what's going on?
Dr. Kern: Yes, good point and that's the main thing. With dissections, unlike other things that can cause pain and some of these other symptoms, pain from a dissection or the discomfort really won’t go away and it is really quite severe. So, patients often do end up in the emergency room but the key there then is very rapid and prompt diagnosis. So, it’s a matter of getting to medical attention quickly and then having the appropriate examination done because once you have examined the patient, it becomes pretty clear what might be going on. Really, the critical step then is usually a CAT scan. A CAT scan in this stand age will absolutely tell us if someone is having a dissection, where the dissection has begun and that has important implications from the standpoint of treatment and what other complications are going on as the result of the dissection.
Melanie: So then, what treatments are available? If it can be life threatening and you are worried about an aortic rupture, what do you do? Is this like a race for time kind of thing? What are the treatments?
Dr. Kern: Sometimes it can be a race for time. As minutes go by, the risk of mortality goes up in patients with a dissection. The treatment options really depend on what area of the aortas is involved or where the dissection has begun. So, if the dissection involves what we call the ascending aorta or the aorta directly above the heart, that truly is a surgical emergency. That is when we drop everything we are doing and those patients need to go right to the operating room and they need to be operated on in order to save their life. In patients whose dissection does not involve the ascending aorta; it starts further from the back, those patients have a number of treatment options available to them depending on the severity of the dissection and what other complications it may be causing. Also in this day and age, we are midst of all kinds of healthcare reform and one of those things is a change in the way we potentially treat dissections. The advent of minimally invasive techniques and new technologies and things called “stent graphs” allows us to treat patients with a very low risk of that treatment and potentially cure them of their dissection but it really is a matter of getting the medical attention as quickly as possible and making the diagnosis as quickly as possible to determine what treatment option is best for that patient.
Melanie: Does that make the person more risk for aneurysm or valve issues? Is that something you look at as well?
Dr. Kern: Absolutely. Patients with dissections involving their ascending aortas--the type that is a surgical emergency--they often do have an associated valve problem. Their main valve in the heart is leaking as result of the dissection. So, part of the operation is intended to fix the valve problem as well. The association with aneurysm is a little bit complex. Patients with aneurysm can be prone to having a dissection within that aneurysm but patients can have dissections without aneurysms, but what happens down the road is you lose the integrity; you lose the strength of the aorta. So, with time, aneurysms can develop in the area of the dissection and that’s the importance for on-going medical surveillance in patients who have had a dissection.
Melanie: Tell us about the prognosis. Can people have an aortic dissection and then go on to live a normal life afterwards or is this something you always have to keep an eye on?
Dr. Kern: Well, the answer to that is also complex and it’s sort of “yes” to both of those and certainly patients, depending on the extent of their dissection, if their dissection just involves the ascending aorta and we are able to completely repair it surgically, they can live a completely normal life. They do need to be evaluated, have periodic CAT scans to make sure everything stays ok, but completely normal. Patients who have more extensive dissections, they certainly need to cut back early on after their treatment, whether we treat them with just medicines or we treat them with stent graphs or surgery but with time, and once we see the aorta stabilize or if they require subsequent operations to totally replace, in time, their entire aorta, then they, too, can lead completely normal lives with normal life expectancy, get back to work and do all those normal things but there may be a period of time when they are not able to do those things.
Melanie: What an amazing topic and fascinating truly. In just the last minute, Dr. Kern, why should patients come to UVA Heart and Vascular Center for their care?
Dr. Kern: Well, I think that at the University of Virginia Heart and Vascular Center, we have the full spectrum of collaborative multi-disciplinary cares specialists who know everything there is to know about dissections. We are also fortunate in that, we have available to us all of the latest treatment options including experimental options; including the latest clinical trials; the latest devices that we are able to put in to tiny incisions in the groin. All of these options are available to treat patients with dissections in the most appropriate way for that individual patient. So, we are not just locked into one form of therapy and we have all the specialists to help treat their medical conditions, the interventionalists, the surgeons, the intensive care doctors and they really get the full spectrum of care.
Melanie: Thank you so much. You’re listening to UVA Health Systems Radio and for more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
What Are Aortic Dissections?
Melanie Cole (Host): Aortic dissections are a serious, potentially fatal condition affecting the aorta, a large blood vessel in your chest. My guest today is Dr. John Kern. He is a board certified thoracic and cardiac surgeon, whose speciality includes treating aortic dissections. Welcome to the show, Dr. Kern. What is an aortic dissection? It sounds to some listeners like a type of surgery but what it is really and what causes them?
Dr. John Kern (Guest): Well, thank you, Melanie. As you pointed out, an aortic dissection concerning to be a life threatening problem. If you think of the aortas, as you pointed out as the largest blood vessel in the body, as a hose that has three layers: an inner layer, a middle layer and an outer layer. You imagine that the inner layer develops a crack in it and then the fluid in the hose; in this case, the blood, can get into that crack and dissect, hence the name dissection, dissect along the length of that hose. Fortunately, in the aorta, the outer layer contributes the most strength to the aorta. So, an aortic dissection can be immediately life-threatening but can very often be treated successfully.
Melanie: So, I'd like to start then with risk factors. Are there some certain risk factors that someone would have for aortic dissection?
Dr. Kern: Yes, certainly there are. In fact, aortic dissections occur most commonly in two periods of your life. In the earlier age populations, those folks in their twenties and thirties and then as we get older in our sixties and seventies. In the younger patients, those folks, their risk factors tend to be connective tissue disorders. So, patients with Marfan syndrome and other connective tissue disorders, which renders the aorta more susceptible to developing a dissection. In older patients, it tends to be a combination of uncontrolled blood pressure and enlarge aortas, so, if you have an aneurysm or if you have a family history of an aneurysm anywhere in your aorta, you should probably be screened to make sure you are not at risk.
Melanie: What about symptoms? Everybody always wants to know symptoms. A lot of things can cause pain in the chest and such, so how would you that this something that's going on?
Dr. Kern: Well, that's exactly right. Aortic dissections certainly do have a classic symptom complex and that tends to be an absolute sudden, out of the blue, if you will, tearing type of chest pain. It can start in the front and go to the back. It can start in the back between the shoulder blades and continue down the back and that literally comes from those layers of the aorta separating. So, that's the most classic symptom complex. For dissections, it’s interesting because we often call dissections “the great imitator.” So, dissections can cause symptoms ranging from a heart attack or a stroke. In fact, dissections can cause a heart attack, so that's why you may have more the classic symptoms of heart attack type chest pain. Since aortic dissections can cause a stroke, so that’s why you may present with a true stroke being paralyzed on one side of your body, but dissections can often be very subtle. Sometimes the pain is not so severe. Sometimes patients just have this nagging back pain or they have belly pain or abdominal pain. Sometimes patients come in because the dissection has occluded blood flow to arm or to a leg. So, they come in with their arm or leg not feeling correct. So, dissections really can be the great imitator. I have seen patients with dissections be misdiagnosed with anything from the flu, all the way down to gall stones and they have ended up having their gall bladder taken out.
Melanie: Well, I would imagine it would be quite confusing because many of these symptoms can mimic other conditions. So, how do you find out? If somebody does get a little nervous about their symptoms, if they got to see a doctor or if they go to an emergency room, is there some sort of diagnosis or exam that would show that this what's going on?
Dr. Kern: Yes, good point and that's the main thing. With dissections, unlike other things that can cause pain and some of these other symptoms, pain from a dissection or the discomfort really won’t go away and it is really quite severe. So, patients often do end up in the emergency room but the key there then is very rapid and prompt diagnosis. So, it’s a matter of getting to medical attention quickly and then having the appropriate examination done because once you have examined the patient, it becomes pretty clear what might be going on. Really, the critical step then is usually a CAT scan. A CAT scan in this stand age will absolutely tell us if someone is having a dissection, where the dissection has begun and that has important implications from the standpoint of treatment and what other complications are going on as the result of the dissection.
Melanie: So then, what treatments are available? If it can be life threatening and you are worried about an aortic rupture, what do you do? Is this like a race for time kind of thing? What are the treatments?
Dr. Kern: Sometimes it can be a race for time. As minutes go by, the risk of mortality goes up in patients with a dissection. The treatment options really depend on what area of the aortas is involved or where the dissection has begun. So, if the dissection involves what we call the ascending aorta or the aorta directly above the heart, that truly is a surgical emergency. That is when we drop everything we are doing and those patients need to go right to the operating room and they need to be operated on in order to save their life. In patients whose dissection does not involve the ascending aorta; it starts further from the back, those patients have a number of treatment options available to them depending on the severity of the dissection and what other complications it may be causing. Also in this day and age, we are midst of all kinds of healthcare reform and one of those things is a change in the way we potentially treat dissections. The advent of minimally invasive techniques and new technologies and things called “stent graphs” allows us to treat patients with a very low risk of that treatment and potentially cure them of their dissection but it really is a matter of getting the medical attention as quickly as possible and making the diagnosis as quickly as possible to determine what treatment option is best for that patient.
Melanie: Does that make the person more risk for aneurysm or valve issues? Is that something you look at as well?
Dr. Kern: Absolutely. Patients with dissections involving their ascending aortas--the type that is a surgical emergency--they often do have an associated valve problem. Their main valve in the heart is leaking as result of the dissection. So, part of the operation is intended to fix the valve problem as well. The association with aneurysm is a little bit complex. Patients with aneurysm can be prone to having a dissection within that aneurysm but patients can have dissections without aneurysms, but what happens down the road is you lose the integrity; you lose the strength of the aorta. So, with time, aneurysms can develop in the area of the dissection and that’s the importance for on-going medical surveillance in patients who have had a dissection.
Melanie: Tell us about the prognosis. Can people have an aortic dissection and then go on to live a normal life afterwards or is this something you always have to keep an eye on?
Dr. Kern: Well, the answer to that is also complex and it’s sort of “yes” to both of those and certainly patients, depending on the extent of their dissection, if their dissection just involves the ascending aorta and we are able to completely repair it surgically, they can live a completely normal life. They do need to be evaluated, have periodic CAT scans to make sure everything stays ok, but completely normal. Patients who have more extensive dissections, they certainly need to cut back early on after their treatment, whether we treat them with just medicines or we treat them with stent graphs or surgery but with time, and once we see the aorta stabilize or if they require subsequent operations to totally replace, in time, their entire aorta, then they, too, can lead completely normal lives with normal life expectancy, get back to work and do all those normal things but there may be a period of time when they are not able to do those things.
Melanie: What an amazing topic and fascinating truly. In just the last minute, Dr. Kern, why should patients come to UVA Heart and Vascular Center for their care?
Dr. Kern: Well, I think that at the University of Virginia Heart and Vascular Center, we have the full spectrum of collaborative multi-disciplinary cares specialists who know everything there is to know about dissections. We are also fortunate in that, we have available to us all of the latest treatment options including experimental options; including the latest clinical trials; the latest devices that we are able to put in to tiny incisions in the groin. All of these options are available to treat patients with dissections in the most appropriate way for that individual patient. So, we are not just locked into one form of therapy and we have all the specialists to help treat their medical conditions, the interventionalists, the surgeons, the intensive care doctors and they really get the full spectrum of care.
Melanie: Thank you so much. You’re listening to UVA Health Systems Radio and for more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.